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BASIC PRINCIPLES OF CORONARY ANGIOGRAPHY AND IMAGING

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Coronary angiography remains the gold standard for imaging coronary anatomy and defining the extent and precise location of coronary artery disease. Optimal coronary angiography is dependent on a thorough knowledge of coronary anatomy and a systematic imaging sequence protocol that enables visualization of all coronary segments, particularly areas of vessel overlap, bifurcations, or tortuous anatomy. A basic map of the coronary anatomy is delineated in Figure 69-1, and the optimal views for imaging each coronary segment are summarized in Table 69-1 (Figs. 69-2, 69-3, 69-4, 69-5). Although standard views are generally consistent from one patient to the next, the precise angulations tend to vary based on the variations in anatomic orientations. A number of coronary segment numbering systems have been established; the most commonly used is the Coronary Artery Surgery Study (CASS) numbering system derived from the Bypass Angioplasty Revascularization Investigation (BARI) study,1 which assigns a unique number to each coronary vessel segment and its branch vessels and has gained wide acceptance in interventional clinical trials (Table 69-2).

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FIGURE 69-1

Schematic diagram of the coronary anatomy. AM, acute marginal artery; CB, conus branch; D, diagonal branch; LAD, left anterior descending artery; LCA, left coronary artery; LCx, left circumflex; OM, obtuse marginal artery; PD, posterior descending artery; PL, posterior lateral artery; RCA, right coronary artery; RV, right ventricular artery; S, septal branch; SN, sinus nodal artery.

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Table 69-1Views for Optimal Visualization of the Coronary Anatomy
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FIGURE 69-2

Anteroposterior view of the left coronary artery. Ideal view to visualize the left main coronary segment.

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FIGURE 69-3

Left anterior oblique (LAO) view of the left and right coronary arteries. Ideal view to visualize the mid and distal left anterior descending and right coronary arteries.

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